Reflux after surgery increases risk of esophageal cancer



Patients who experience recurrent reflux despite surgical treatment are three times more likely to develop esophageal adenocarcinoma than are those who have a successful surgery.

The findings of a national database study suggest that careful observation may be key to prevention of cancer when antireflux surgery doesn’t deliver, reported Dr. Hedvig E. Lofdahl and colleagues. The study was published in the April issue of Annals of Surgery.

"From a clinical point of view, this study suggests that it might be valuable to carefully evaluate the result of the antireflux surgery, and consider the patients with recurrent GERD, particularly those with Barrett’s esophagus, for endoscopic surveillance," wrote Dr. Lofdahl of Karolinska Institutet, Stockholm, and his coauthors (Ann. Surg. 2013;257:579-82).

The case-control study drew its data from the Swedish Cancer Register. It comprised 295 patients who underwent antireflux surgery from 1996 to 2006. Fifty-five of the patients developed an adenocarcinoma of the esophagus sometime during the 7-year follow-up period.

Most of the patients in the study were male (87%). Smoking status did not differ significantly between the cases and controls (47% vs.42%, respectively). Recurrent reflux was significantly more common among the cases than among the controls (35% vs. 18%).

The multivariate analysis controlled for body mass index, smoking, and the type of antireflux surgery. In the final adjusted model, recurrent reflux conferred a threefold increase in the risk of a later esophageal adenocarcinoma. A BMI of more than 25 kg/m2 also increased the risk, but not significantly (odds ratio [OR] 1.6; confidence interval [CI]: 0.8-3.5). There were not enough patients with a BMI of greater than 30 kg/m2 to further tease out the effect of weight.

Having ever smoked tobacco also increased the risk of esophageal cancer, but again, the increase was not statistically significant (OR 1.4; CI: 0.7-2.8).

Compared with a partial fundoplication, a total 360-degree fundoplication was associated with a lower risk of cancer, but the difference was not statistically significant (OR 0.6; CI: 0.3-1.3).

"This finding might at least partly explain the lack of cancer-preventive effect of antireflux surgery," the investigators wrote.

The study was supported by the Swedish Research Council, the Swedish Cancer Society, and the Stockholm Cancer Society. None of the authors had financial disclosures.

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